Predicting Preoperative Rupture from Imaging Alone in Acute Type A Aortic Dissection

Abstract

Objective. To establish risk factors for predicting preoperative ruptures in patients with acute type A aortic dissection (ATAAD) based on computed tomography angiography (CTA) imaging features alone. Methods. We retrospectively reviewed patients with ATAAD treated between January 2017 and December 2021 in Fujian Medical University Union Hospital, China. The primary outcome was preoperative rupture after admission. Multivariate logistic regression analysis was performed based on basic characteristics and CTA imaging variables selected by the application of the least absolute shrinkage and selection operator. Results. A total of 564 patients were enrolled. The rate of preoperative rupture was 14.2% (n = 80). Patients who experienced rupture were significantly older ( $P$ = 0.002) and had a higher rate of DeBakey II ( $P$ = 0.016), syncope ( $P$ = 0.003), ventilator-assisted ventilation ( $P$ = 0.008), preoperative shock ( $P$ = 0.040), hypotensive state ( $P$ = 0.009), hepatic insufficiency ( $P$ = 0.002), acute kidney injury ( $P$ = 0.045), and moderate or massive pericardial effusion ( $P$ = 0.007). Multivariate analysis identified the following independent risk factors for preoperative rupture based on CTA imaging features: DeBakey II (odds ratio (OR) = 1.988, 95% confidence interval (CI) 1.211–3.676, $P$ = 0.009), ascending aorta diameter (OR = 2.077, 95% CI 1.335–4.045, $P$ < 0.001), ascending aorta false lumen diameter (OR = 2.988, 95% CI 2.055–4.291, $P$ < 0.001), ascending aorta false lumen/true lumen diameter ratio >4 : 1 (OR = 3.129, 95% CI 2.031–6.225, $P$ < 0.001), and number of branch arteries involved in dissection >6 (OR = 1.154, 95% CI 1.036–2.006, $P$ = 0.036). Conclusions. CTA imaging features are one of the most convenient indicators for the early prediction of preoperative rupture in patients with ATAAD.